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Nursing Home Care

A commonly held belief is that once a loved one is placed in a nursing home, the family’s job is complete. Nothing could be further from the truth. In actuality, that loved one still needs an advocate for appropriate care.

This past year marked the 20th anniversary of the passage of the Nursing Home Reform Act. The intent of the law was to improve the quality of nursing homes by establishing higher standards of care. The Act granted more rights to the residents of nursing homes, increased staffing at these homes, and granted residents the specific right to be free from “abuse, mistreatment, and neglect”. Lets look at some of the benefits resulting from the Nursing Home Reform Act.

Nursing facilities are responsible for assisting residents in the maintenance of daily living activities, including the ability to bathe, dress, and groom; transfer and ambulate; toilet; eat; and use speech, language, or other functional communication.

Preadmission screening and annual resident reviews are to be conducted for residents with mental illnesses and certain other chronic conditions. Such measures ensure that residents are not inappropriately being held in nursing homes, and that those properly placed in nursing homes receive appropriate services.

Physical restraints are specifically prohibited for discipline or convenience, and specific indications are required for the use of antipsychotic medications to reduce their use as chemical restraints.

A range of other support services are to be provided or arranged, including social activities; medically related social services; dietary services; physician and emergency care services; and pharmacy, dental, and rehabilitation services such as physical, speech, and occupational therapies.

Residents are to be assessed upon entry and then periodically after that. The assessment is to be used to develop a written plan of care, periodically reviewed and revised, by a team including the attending physician and a registered nurse. The law specifies the creation of a new, standardized, “reproducible,” comprehensive functional assessment tool that is to be used to assess all residents. This tool generates a data set to be used for clinical assessment and individualized care planning for each resident. The data set is also to be a resource for facilities to measure and improve their overall performance, and available for regulators to track resident outcomes.

The law and regulations also establish a number of quality-of-life rights along with the standards on quality of care. These rights included the right:

  • to freedom from abuse, mistreatment, and neglect;
  • to freedom from physical restraints;
  • to privacy;
  • to accommodation of medical, physical, psychological, and social needs;
  • to participation in resident and family groups;
  • to be treated with dignity;
  • to exercise self-determination;
  • to communicate freely;
  • to participate in the review of one’s care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility; and
  • to voice grievances without discrimination or reprisal.

As a follow-up to the Act, the Kaiser Family Foundation has compiled a report on the actual improvements seen in nursing homes over the last twenty years. The fear of a prison-like atmosphere of confinement is slowly becoming something of the past, as not only has there been a significant “reduction in the use of physical restraints,” but also the records of residents being restrained was less than six percent.

Let me emphasis that great improvements have been made. There is a real trend toward “family friendly” facilities that have much more of a home-like atmosphere.

However, there is still much need for improvement, and all health care professionals should do their part to ensure the continued positive enhancement of nursing homes. Almost one-fifth of certified nursing homes have still been cited for violations. These citations have been for “deficiencies that caused harm or immediate jeopardy to residents”. Moreover, many facilities are still understaffed.

Placement in a nursing home requires that a family continue to be an advocate and spokesperson for the resident. Contrary to the belief that the family’s job is done, the family’s role may be more important than ever before.

Soon we will have an article about how to be sure you get good care in an institution.


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